Documente Academic
Documente Profesional
Documente Cultură
Lean Thinking
The proliferation of Lean Thinking was facilitated by the publication of Womack, Jones,
and Roos (1990). Lean, as it is often abbreviated, represents a fundamental break with
Six Sigma
Six Sigma was originally a concept for
company-wide QI introduced by Motorola
in 1987. It was further developed by General
The Red Cross Hospital experience illustrates the key elements of the Lean Six
Sigma approach. First, the hospital applied
the organizational infrastructure typical of
Six Sigma. Second, deployment of QI was
project by project. Third, the Lean Six Sigma
approach was based on developing organizational competency for innovation by training
a dedicated force of Lean Six Sigma project
leaders and GBs. Fourth, project selection
had a strategic focus. In the present case the
Dutch Ministry of Welfare and Health had
imposed serious budget cuts on the Red
Cross Hospital. This necessitated a strict
focus on cost reductions while maintaining or possibly improving quality. Potential
projects were suggested by Champions, all
hospital department heads. The final word to
proceed was given by the general manager,
based on an evaluation of the projects strategic relevance.
Maintenance
The Red Cross Hospital has a system in
place to manage mechanical breakdowns and
irregularities. This system registers a problem
and assigns a maintenance person a blue
coupon with a description of the issue. After
diagnosing the situation and solving the problem, the maintenance person reports that the
problem has been solved. Although the system itself seemed efficient, the resolution of
problems often took an excessive amount of
time. A project team was chartered with the
task of improving the process. The CTQs were
the number of active, not yet resolved blue
coupons and the lead time per blue coupon.
10
Conclusions
Unless healthcare leaders deal with spiraling
healthcare costs, a decreasing proportion of the
citizens of industrialized societies will be able
to afford high-quality healthcare. If healthcare
services are inefficient, they cost more, and
fewer can benefit from the technical advances
of modern medicine. A persistence of traditional service practices will drain our economy.
Continuous and relentless pursuits of innovations in the service delivery process are necessary. The industrialization of healthcare offers
a viable alternative that can provide better
economy, greater efficiency, and better service.
Industrializing healthcare does not mean that
healthcare becomes less personal and that quality
standards are compromised. For example, a modern car, objectively speaking, is far cheaper and
of significantly higher quality than a handcrafted
car manufactured 100 years ago. Prepackaged
vacations typically offer better deals with higher
levels of service than individually planned tours.
Industrialization of services typically improves
quality while making those services much more
cost efficient.
The industrialization of healthcare service
will require a large number of innovations,
especially pertaining to the delivery of services.
The popular perception is that innovation, like
artistic expression, is the product of genius.
However, in todays competitive economic environment, this process must not remain a mystery. Indeed, it need not be. Pianists and painters
attend conservatories and art schools to receive
intensive training in their profession. Innovation,
like artistic performance, can be learned. The
combination of Six Sigma and Leanwith their
tools, road maps, and management processesis essentially a carefully managed process
for systematically scheduling and carrying out
innovation projects that can be taught, learned,
and performed with a high degree of success.
Lean and Six Sigma have strongly complementary strengths that are particularly useful
for systematically developing healthcare service innovations. Synthesizing these approaches leads to an integrated program combining
the best of both programs. Lean Six Sigma
incorporates the organizational infrastructure
and the thorough diagnosis and analysis tools
of Six Sigma with Lean analysis tools and bestpractice solutions for problems dealing with
waste and unnecessary time consumption.
The application at the Red Cross Hospital provides an illustration of the significant benefits of
the Lean Six Sigma approach. The management
of the hospital adopted the Lean Six Sigma organizational infrastructure, developed organizational
competencies, and instituted a process for selecting strategically aligned projects combined with
rigorous project management. The net result was a
process for institutionalized systematic innovation
that consistently delivers the intended end results
(Drucker, 1985). The adoption of similar programs
will make possible the successful replication of
the outstanding results obtained by the Red Cross
Hospital in Beverwijk, the Netherlands.
Acknowledgments
The authors acknowledge Sue Ellen Bisgaard and
Selena Kaplan for their editorial assistance and
References
Bisgaard, S., & De Mast, J. (in press). After Six Sigma
Whats next? Quality Progress.
Bisgaard, S., & Freiesleben, J. (2004). Six Sigma and the
bottom line. Quality Progress, September, 37, 5762.
Box, G. E. P., & Bisgaard, S. (1987). The scientific context of
quality improvement. Quality Progress, June, 20, 5461.
Breyfogle, F. W. (2003). Implementing Six SigmaSmarter solutions using statistical methods (2nd ed.). New York: Wiley.
De Koning, H., & De Mast, J. (in press). A rational
reconstruction of Six Sigmas breakthrough cookbook. International Journal of Quality and Reliability
Management, 23(5).
Drucker, P. F. (1985). Innovation and entrepreneurship:
Practice and principles. New York: Harper and Row.
Ford, H., & Crowther, S. (1926). Today and tomorrow.
Cambridge, MA: Productivity Press.
Garvin, D. A. (1988). Managing quality: The strategic and
competitive edge. New York: Free Press.
George, M. L. (2003). Lean Six Sigma for services. New York:
McGraw-Hill.
Harry, M. J. (1997). The vision of Six Sigma (5th ed.).
Phoenix: Tri Star.
Heskett, J. L., Sasser, W. E., Jr., & Schlesinger, L. A. (1997).
The service profit chain. New York: Free Press.
Hoerl, R. W. (2004). One perspective on the future of Six
Sigma. International Journal of Six Sigma and Competitive
Advantage, 1(1), 112119.
Juran, J. M. (1989). Juran on leadership for quality. New York:
Free Press.
Levitt, T. (1976). The industrialization of service. Harvard
Business Review, SeptemberOctober, 54, 6374.
Ohno, T. (1988). Toyota production system. New York:
Productivity Press.
Pyzdek, T. (2001). The Six Sigma handbookA complete
guide for greenbelts, blackbelts, and managers at all levels.
New York: McGraw-Hill.
Pyzdek, T. (2004). Strategy deployment using balanced
scorecards. International Journal of Six Sigma and
Competitive Advantage, 1(1), 2128.
Robinson, A. (1990). Modern approaches to manufacturing improvement: The Shingo system. Cambridge, MA:
Productivity Press.
Rosenberg, N. (1982). Inside the black box: Technology and
economics. New York: Cambridge University Press.
Shingo, S. (1989). A study of the Toyota production system.
New York: Productivity Press.
Smith, B. (2003). Lean and Six SigmaA one-two punch.
Quality Progress, April, 36, 3741.
Snee, R. D. (2004). Six Sigma: The evolution of 100 years of
business improvement methodology. International Journal
of Six Sigma and Competitive Advantage, 1(1), 420.
Snee, R. D., & Hoerl, R. W. (2004). Six Sigma beyond the factory floor. Upper Saddle River, NJ: Pearson Education.
Stalk, G., & Hout, T. M. (1990). Competing against time.
New York: Free Press.
Standard, C., & Davis, D. (1999). Running todays factory:
A proven strategy for Lean manufacturing. Cincinnati:
Hanser Gardner.
Van den Heuvel, J., Does, R. J. M. M., & Bisgaard, S.
(2005). Dutch hospital implements Six Sigma. Six Sigma
Forum Magazine, 4(2), 1114.
Authors Biographies
Henk de Koning, MSc, studied physics and psychology
at the University of Utrecht, the Netherlands. He is a
consultant at the Institute for Business and Industrial
Statistics (IBIS UvA), teaching courses in Six Sigma and
supervising improvement projects in Dutch industry. His
PhD thesis will present the results of a scientific study of
Six Sigma methodology.
John P. S. Verver, MSc, studied mechanics at the University
of Twente, the Netherlands. He worked as a Black Belt at
DAF Trucks (a Paccar company). Currently, he works as a
Master Black Belt at the Red Cross Hospital in Beverwijk
and at the Canisius Wilhelmina Hospital in Nijmegen.
Jaap van den Heuvel, MD MBA, studied medicine at the
University of Leiden and business administration at the
University of Rotterdam, the Netherlands. For 7 years
he was CEO at the Red Cross Hospital in Beverwijk.
Currently, he is CEO at the Canisius Wilhelmina Hospital
in Nijmegen.
Soren Bisgaard, PhD, earned a doctorate in statistics from
the University of WisconsinMadison. Currently he is a
professor of technology management at the University of
Massachusetts, Amherst.
Ronald J. M. M. Does, PhD, earned a doctorate in mathematical statistics from the University of Leiden, the
Netherlands. Currently he is a professor in industrial statistics at the University of Amsterdam and general manager of the Institute for Business and Industrial Statistics
(IBIS UvA).
For more information on this article, contact Henk de
Koning by e-mail at hkoning@science.uva.nl.
11